Feasibility and safety of uniport robotic-assisted thoracoscopic surgery in initial series of anatomical pulmonary resections under learning curve.

OBJECTIVES: Uniport robotic assisted thoracoscopic surgery (U-RATS) is a recently adopted approach in thoracic surgery and is assumed to require a learning curve for surgeons because of technical difficulties. We aimed to verify the feasibility and safety of solo surgery in U-RATS in an initial series of patients, comparing with initial series of uniport video-assisted thoracoscopic surgery (U-VATS). METHODS: The surgical and post-operative outcomes of 25 U-RATS cases were compared with 25 U-VATS cases. The da Vinci Xi Surgical System was used for U-RATS procedure. In both groups, the skin incisions were 4 cm in length, and a 30-degree camera was placed at the posterior and upper edges of the incision. RESULTS: Between June and December 2023, 25 patients with lung malignancies underwent anatomical pulmonary resection via U-RATS, including 13 lobectomies and 12 segmentectomies. Patient characteristics did not differ between the groups. The short-term outcomes were similar between the U-RATS and U-VATS groups, except for operation time (median: 214 vs. 157 min, p = 0.0035). The pain scores on postoperative days 1 and 3 were significantly lower in patients who underwent U-RATS than in those who underwent U-VATS (median: 0 vs. 2, p = 0.010; median: 0 vs. 0, p = 0.027, respectively). CONCLUSIONS: The short-term outcomes are similar between the U-RATS and U-VATS groups, except for operation time. U-RATS is considered to be feasible and safe in the initial series of anatomical pulmonary resections performed by a surgeon who was under the learning curve.

Comparison of laser guidance and freehand hook-wire for CT-guided preoperative localization of pulmonary nodules.

PURPOSE: In VATS surgery, precise preoperative localization is particularly crucial when dealing with small-diameter pulmonary nodules located deep within the lung parenchyma. The purpose of this study was to compare the efficacy and safety of laser guidance and freehand hook-wire for CT-guided preoperative localization of pulmonary nodules. METHODS: This retrospective study was conducted on 164 patients who received either laser guidance or freehand hook-wire localization prior to Uni-port VATS from September 1st, 2022 to September 30th, 2023 at The First Affiliated Hospital of Soochow University. Patients were divided into laser guidance group and freehand group based on which technology was used. Preoperative localization data from all patients were compiled. The localization success and complication rates associated with the two groups were compared. The risk factors for common complications were analyzed. RESULTS: The average time of the localization duration in the laser guidance group was shorter than the freehand group (p<0.001), and the average CT scan times in the laser guidance group was less than that in the freehand group (p<0.001). The hook-wire was closer to the nodule in the laser guidance group (p<0.001). After the localization of pulmonary nodules, a CT scan showed 14 cases of minor pneumothorax (22.58%) in the laser guidance group and 21 cases (20.59%) in the freehand group, indicating no statistical difference between the two groups (p=0.763). CT scans in the laser guidance group showed pulmonary minor hemorrhage in 8 cases (12.90%) and 6 cases (5.88%) in the freehand group, indicating no statistically significant difference between the two groups (p=0.119). Three patients (4.84%) in the laser guidance group and six patients (5.88%) in the freehand group had hook-wire dislodgement, showing no statistical difference between the two groups (p=0.776). CONCLUSION: The laser guidance localization method possessed a greater precision and less localization duration and CT scan times compared to the freehand method. However, laser guidance group and freehand group do not differ in the appearance of complications such as pulmonary hemorrhage, pneumothorax and hook-wire dislodgement.

Uniportal video-assisted thoracoscopic surgery in the prone position for esophageal bronchogenic cyst.

Esophageal bronchogenic cysts are very rare. A bronchogenic cyst is a congenital malformation resulting from abnormal sprouting of primitive bronchi because of a foregut bronchopulmonary malformation. An 18-year-old patient with a cystic tumor in the left posterior mediastinum was identified. The mediastinal tumor was removed by uniportal video-assisted thoracoscopic surgery. The operation was performed in the prone position through a single 4-cm incision on the lateral scapular line in the left ninth intercostal space. After tumor resection, the dissected esophageal muscle and mediastinal pleura were sutured with two continuous barbed sutures. The operation took 80 min. A biopsy confirmed the diagnosis of esophageal bronchial cyst. Diet was started on the evening of the operation. The chest tube was removed on the 1st postoperative day, and the patient was discharged without any problems on the 2nd postoperative day.

Comparison of uniport versus triport thoracoscopic single or combined basal segmentectomy for stage IA lung cancer.

Background: Single or combined basal segmentectomy (CBS), excluding common basal segmentectomy, is the most difficult of all types of segmentectomies. The purpose of this study was to compare the perioperative outcomes and oncological prognosis between uniport thoracoscopic basal segmentectomy (UTBS) and triport thoracoscopic basal segmentectomy (TTBS). Methods: This study retrospectively collected 300 patients who underwent thoracoscopic single or CBS at the West China Hospital of Sichuan University from April 2015 to May 2022, including 67 and 233 patients in the UTBS and TTBS groups, respectively. Propensity score matching (PSM) was used to reduce confounding bias between the two groups. The primary outcome was recurrence-free survival (RFS). The secondary outcomes were overall survival (OS) and perioperative outcomes. Results: After PSM, the UTBS group (n=64) had significantly less intraoperative blood loss than the TTBS group (n=64) (20 vs. 30 mL, P=0.001). Other perioperative outcomes, including the operation time, number of lymph nodes and lymph node stations harvested, duration of chest tube drainage, postoperative hospital stay, and postoperative complications, were comparable. Subgroup analysis demonstrated that the operative time in the group underwent single basal segmentectomy (SBS) was significantly shorter compared to the group underwent CBS (110 vs. 120 min, P=0.002). There were 5 cases of recurrence in the overall cohort and no recurrence in the matched cohort. No deaths were observed in the overall cohort. Therefore, a survival analysis was conducted only for RFS in the overall cohort. The RFS rate and OS rate of the overall cohort were 98.3% and 100%, respectively. The surgical approach (UTBS vs. TTBS) was not an independent risk factor for RFS (HR: 1.120, 95% CI: 0.342-13.051, P=0.879). Conclusions: UTBS provided similar perioperative outcomes and oncological prognoses compared to TTBS.

Single port thoracoscopic diaphragm plication: A novel treatment approach to bilateral phrenic nerve palsy and diaphragm paralysis.

INTRODUCTION AND IMPORTANCE: The diaphragm is the primary muscle of respiration. Bilateral paralysis of the diaphragm due to phrenic nerve palsy causes severe dyspnoea and is life threatening. Diaphragmatic Plication has shown great promise in treating diaphragm paralysis and has evolved as operative treatment from an open thoracotomy to multiport and robotic video assisted thoracoscopic surgery. CASE PRESENTATION: Here we present a case of idiopathic bilateral diaphragm paralysis resulting significant deterioration in lung function tests, supplemental oxygen, and ventilator dependence. The patient was treated with a 2-stage operative plication of each hemidiaphragm through a 2.5 cm single incision thoracoscopic technique, which resulted in normalization of lung function tests, elimination of oxygen dependence and negligible analgesia requirements. CASE DISCUSSION: This is the first case reported in the literature of a single port VATS plication of the diaphragm for the treatment of bilateral phrenic nerve palsy. Surgery, specifically diaphragm plication, is indicated for patients with significant symptoms and persistent paralysis. Video-assisted thoracoscopic surgery (VATS) has evolved from open operations to smaller incisions, offering improved lung function, postoperative pain, hospital stay, morbidity, and mortality. CONCLUSION: Single port diaphragmatic plication is a novel approach to the treatment of bilateral phrenic nerve palsy. We make the case for indication of the technique for treatment of diaphragmatic paralysis.

Auxin transport at the endoplasmic reticulum: roles and structural similarity of PIN-FORMED and PIN-LIKES.

Auxin is a crucial plant hormone that controls a multitude of developmental processes. The directional movement of auxin between cells is largely facilitated by canonical PIN-FORMED proteins in the plasma membrane. In contrast, non-canonical PIN-FORMED proteins and PIN-LIKES proteins appear to reside mainly in the endoplasmic reticulum. Despite recent progress in identifying the roles of the endoplasmic reticulum in cellular auxin responses, the transport dynamics of auxin at the endoplasmic reticulum are not well understood. PIN-LIKES are structurally related to PIN-FORMED proteins, and recently published structures of these transporters have provided new insights into PIN-FORMED proteins and PIN-LIKES function. In this review, we summarize current knowledge on PIN-FORMED proteins and PIN-LIKES in intracellular auxin transport. We discuss the physiological properties of the endoplasmic reticulum and the consequences for transport processes across the ER membrane. Finally, we highlight the emerging role of the endoplasmic reticulum in the dynamics of cellular auxin signalling and its impact on plant development.

A uniport subxiphoid approach with a modified sternum retractor is safe and feasible for anterior mediastinal tumors.

Background: Minimally invasive surgery has been used to treat anterior mediastinal tumors. This study sought to describe a single team's experience of uniport subxiphoid mediastinal surgery using a modified sternum retractor. Methods: Patients who underwent uniport subxiphoid video-assisted thoracoscopic surgery (USVATS) or unilateral video-assisted thoracoscopic surgery (LVATS) from September 2018 to December 2021 were retrospectively enrolled in this study. A 5-cm vertical incision approximately 1-cm caudal to the xiphoid process was usually made followed by the installment of a modified retractor, which was able to raise the sternum by 6-8 cm. Next, the USVATS was performed. In the unilateral group, 3 1-cm incisions were usually made, among which, 2 are made in the 2nd or 3rd and 5th intercostal anterior axillary line, and the 3rd was made in the 5th intercostal midclavicular line. In some instances, an additional subxiphoid incision was made to remove the large tumors. All the clinical and perioperative data, including the prospectively recorded visual analogue scale (VAS) score, were analyzed. Results: In total, 16 patients who underwent USVATS and 28 patients who underwent LVATS were enrolled in this study. With the exception of tumor size (USVATS 7.9±1.6 cm vs. LVATS 5.1±2.4 cm, P<0.001), the baseline data of the patients in the 2 groups were comparative. Blood loss in surgery, conversion, draining duration, postoperative stay, postoperative complications, pathology and tumor invasion were similar between the 2 groups. Although the operation time was significantly longer in the USVATS group than the LVATS group (115±19 vs. 83±30 min, P<0.001), the VAS score at 1st postoperative day (1.9±1.1 vs. 3.1±1.1, P<0.001) and moderate pain level (a VAS score >3) (6.3% vs. 32.1%, P=0.049) were better in the USVATS group than the LVATS group. Conclusions: Uniport subxiphoid mediastinal surgery is a feasible and safe procedure, especially for large tumors. Our modified sternum retractor is especially helpful during uniport subxiphoid surgery. Compared to lateral thoracic surgery, this approach has the advantages of less injury and lower postoperative pain, which may lead to a faster recovery. However, its long-term follow-up outcomes need to be observed.

Complete uni-port video-assisted thoracoscopic surgery for surgical stabilization of rib fractures: a case report.

BACKGROUND: Rib fractures are a common injury in trauma. Potential complications include pain, pneumonia, respiratory failure, disability, and death. Surgical stabilization of rib fractures (SSRF) has become an available treatment option, and complete video-assisted thoracoscopic surgery (VATS) for SSRF is gradually accepted because of minimally invasive and pain relief. To our knowledge, complete uni-port VATS for SSRF has not yet been reported. CASE PRESENTATION: A 53-year-old man accidentally fell off a three-meter high scaffolding while working resulting in severe chest pain and shortness of breath. He was found with left 7th through 11th rib fractures with a pulmonary contusion from computed tomography (CT). A 4 cm incision was made in the 7th intercostal space in the midaxillary line, and complete uni-port VATS for SSRF were operated. The patient's pain was significantly relieved after the operation, and the scar was tiny and unapparent. CONCLUSIONS: Complete uni-port VATS for SSRF is a novel and modificatory method of operation with the benefit of minimal invasion, meanwhile, intrathoracic injuries could be treated at the same time. Further study is warranted.

[Application of Three-dimensional Computed Tomography Bronchography and 
Angiography Combined with Perfusion Area Identification Technique 
in Uniport Thoracoscopic Complex Segmentectomy].

BACKGROUND: With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy. METHODS: From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed. RESULTS: The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases. CONCLUSIONS: The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.

Application of Three-dimensional Computed Tomography Bronchography and Angiography Combined with Perfusion Area Identification Technique in Uniport Thoracoscopic Complex Segmentectomy / 中国肺癌杂志

BACKGROUND@#With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy.@*METHODS@#From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed.@*RESULTS@#The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases.@*CONCLUSIONS@#The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.

The perioperative outcomes of uniport versus two-port and three-port video-assisted thoracoscopic surgery in lung cancer: a systematic review and meta-analysis.

BACKGROUND: Uniport video-assisted thoracoscopic surgery (VATS) has been applied widely for the treatment of lung cancer in recent years. Some studies have reported that uniport VATS might provide better outcomes than multiport VATS. However, the perioperative outcomes of uniport VATS compared with two-port and three-port VATS, respectively, have yet to be studied at a comprehensive scale. This meta-analysis study compares the perioperative efficacy among uniport, two-port, and three-port VATS. METHODS: We searched studies published before October 1, 2019, by using Web of Science databases, Ovid Medline, Embase, and PubMed. Studies that compared uniport VATS with two-port or three-port VATS for patients with lung cancer were included. Operative time, perioperative blood loss, number of lymph nodes retrieved, conversion rate, duration of postoperative chest tube drainage, length of hospital stay (LoS), visual analogue pain scores on postoperative day (POD) 1 and POD 3, and overall morbidity were evaluated. RESULTS: Sixteen studies that compared uniport VATS with two-port or three-port VATS in the treatment of lung cancer were included. Uniport VATS showed less blood loss, a shorter duration of postoperative drainage and a lower visual analogue pain score on POD 3 than two-port VATS; it showed a shorter duration of postoperative drainage, a shorter LoS, and lower visual analogue pain scores on POD 1 and POD 3 than three-port VATS. There were no significant differences in the number of lymph nodes retrieved, operative time, conversion rate, and overall morbidity rate when comparing uniport VATS with two-port VATS or three-port VATS. CONCLUSIONS: Uniport VATS might provide better perioperative outcomes than either two-port or three-port VATS in lung cancer treatment.

The feasibility of thoracoscopic-guided intercostal nerve block during uniportal video-assisted thoracoscopic lobectomy of the lung.

Background: Uniportal thoracoscopic surgery has become widely accepted for its favourable outcomes with regard to pain. However, post-operative pain is still a concern associated with thoracic surgery. The objective of this study was to evaluate the post-operative pain of patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomies using an intra-operative intercostal nerve block. Methods: All consecutive patients undergoing uniportal VATS lobectomies between October 2018 and October 2019 were reviewed retrospectively. Twenty consecutive patients in Group A underwent uniportal VATS lobectomies without intra-operative intercostal nerve blocks. The other 20 consecutive patients in Group B underwent uniportal VATS lobectomies with intra-operative intercostal nerve blocks. Numeric Pain Rating Scale (NRS) scores were recorded at 1, 12 and 24 h postoperatively. The number of anti-inflammatory drugs (non-steroidal anti-inflammatory drug [NSAIDs]) consumed until the time of chest tube removal was also recorded. Results: There was no difference between the groups with regard to sex, age, chest tube duration, length of stay, operative time or laterality. There was a significant difference in post-operative NRS scores at 1 h (P < 0.001) and 12 h (P = 0.014) between the groups. The NSAID consumption was significantly lower in Group B than in Group A (P = 0.038). Conclusion: Intra-operative intercostal nerve blocks with bupivacaine provided immediate post-operative pain relief and reduced post-operative opioid consumption in patients who underwent uniportal VATS lobectomies.

A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung.

BACKGROUND AND AIMS: Uniportal thoracoscopic surgery has been reported to result in alleviating the postoperative pain when compared with traditional video-assisted thoracoscopic surgery (VATS). However, postoperative pain is still the main concerns associated with thoracic surgeries. The objective of this study is to evaluate the postoperative pain of patients undergoing uniportal VATS, especially wedge resection, with the use of intraoperative intercostal nerve block. METHODS: All consecutive patients undergoing the uniportal VATS wedge resection between January 2019 and March 2020 were reviewed retrospectively. Twenty consecutive patients in Group A underwent the uniportal VATS wedge resection without intraoperative intercostal nerve block. The other 20 consecutive patients in Group B underwent the uniportal VATS wedge resection with intraoperative intercostal nerve block. The numeric pain rating scale (NRS) scores were recorded at 1, 12, and 24 h, postoperatively. The number of opioid consumption was also recorded until the time to chest tube removal. RESULTS: There was no difference between groups with regard to sex, age, chest tube duration, length of stay, operative time, laterality time, and diagnosis. There was a significant difference in postoperative NRS scores at 1 h (P = 0.001) and 12 h (P = 0.022) between the groups. The opioid consumption was significantly in Group B lower than those in Group A (P = 0.025). CONCLUSION: The intraoperative intercostal nerve block with bupivacaine provided immediate postoperative pain relief with reducing the postoperative opioid consumption compared in patients who underwent uniportal VATS, especially wedge resection of the lung.

Resection of Thymic Neuroendocrine Carcinoma Guided by Three-Dimensional Reconstruction: A Case Report.

Primary thymic small cell neuroendocrine carcinoma (SCNEC), which possesses a more aggressive biological behaviour, including invasion of proximal structures, local recurrence, and distant metastasis, is extremely rare. According to a previous literature report, only a few patients with this disease have been reported, compared to patients with distant metastasis of bones, lungs, spleen, liver, and adrenal glands (1, 2). The report data suggest that SCNEC is a highly malignant tumour compared to most other tumours of the human body. In this study, we presented the case of a patient who underwent surgery guided by three-dimensional reconstruction modelling before the operation. We were fully prepared for the resection of this tumour using three-dimensional reconstruction modelling, even after reading the computed tomography (CT) images that showed a closed relationship with the pericardium, the vein of the right middle lung lobe, and the phrenic nerve. All these features demonstrate that SCNEC is highly malignant. To date, there are no procedural reports for three-dimensional reconstruction modelling in malignant thymus tumours.

Indocyanine green fluorescence-navigated thoracoscopy versus traditional inflation-deflation approach in precise uniportal segmentectomy: a short-term outcome comparative study.

Background: Uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy is widely used in the field of thoracic surgery. However, anatomical variations in the bronchi and lung vessels may be critical obstacles during precise pulmonary segmentectomy. Thus, it is necessary to optimize uniportal VATS segmentectomy and to accurately identify the plane between lung segments by precisely transecting the bronchi and blood vessels of the lung segments. The indocyanine green fluorescence (ICGF)-based method has the potential to be a feasible and effective technique to facilitate the uniportal VATS segmentectomy. The present study aims at comparing the short-term outcomes of ICGF versus the traditional inflation-deflation method for uniportal VATS segmentectomy. Methods: The perioperative clinical data in 200 consecutive patients undergoing uniportal VATS segmentectomy from December 2018 to August 2020 at Shanghai Chest Hospital were analyzed retrospectively. The targeted segment structures were identified and dissected precisely by using ICGF-based (N=100) or the traditional inflation-deflation (N=100) methods. The parameters of intraoperative blood loss and operation time, postoperative drainage volume, air leakage time, drainage tube retention time, length of hospital stay, and complications in the ICGF group were collected. Further, the operation time between the ICGF and the inflation-deflation groups was compared. The data summary and statistical analysis were performed by SPSS 19.0. P value <0.05 was considered statistically significant. Results: No massive hemorrhage, hypoxemia, allergy, conversion to lobectomy, or wedge resection was noted during the surgery. ICGF groups resulted in a shorter operative time (90±11.46 vs. 118±10.59 min, P<0.001). No postoperative complications were observed, e.g., bronchopleural fistula, hemoptysis, or atelectasis. All patients were discharged as routinely scheduled. No disease recurrence or metastasis was found during the follow-ups. Conclusions: Our study indicated that the ICGF-based navigation approach is a simple, effective, and reliable technique that can greatly facilitate the uniportal VATS segmentectomy.

Current opinion and comparison of surgical procedures for the treatment of primary spontaneous pneumothorax.

INTRODUCTION: Although three-port video-assisted thoracoscopic surgery (VATS) is the standard radical treatment for primary spontaneous pneumothorax (PSP), several issues need to be addressed as the postoperative recurrence rate remains relatively high. Although bullectomy is effective in preventing the postoperative recurrence of PSP, recurrent pneumothorax often occurs, requiring additional methods such as pleural covering with absorbable mesh sheets, surgical chemical pleurodesis, pleural abrasion, or pleurectomy. In addition, minimally invasive approaches that exceed three-port VATS are required according to the social demand. These approaches, such as uniportal VATS, reduced port surgery, and needlescopic surgery, have cosmetic merits, lower postoperative pain, and similar surgical results as three-port VATS. AREAS COVERED: We focused on conventional and novel treatments for PSP in this article. EXPERT OPINION: Effective methods that prevent postoperative recurrence and minimally invasive approaches will become popular in the near future.

A dense fissure is not a contra-indication for uniportal thoracoscopic lobectomy.

Background: A dense fissure is a main cause of a postoperative prolonged air leak (PAL). Such a fissure, if exposed, sometimes incidentally injures the pulmonary artery. We investigated whether uniportal thoracoscopic lobectomy which is considered technically more difficult than the conventional multiportal approach was appropriate for patients with dense fissures. Methods: From February 2019 to January 2022, 140 patients with primary lung cancer underwent uniportal thoracoscopic lobectomy with ≥ ND2a-1 lymphadenectomy. Patients were divided into those with dense (n=22) and separated (n=118) fissures. All dense fissures were treated using a fissureless technique without exposure of the pulmonary artery. We compared the characteristics and perioperative results of the two groups. We used multivariate analysis to identify factors predictive of PAL. Results: Although dense fissures were significantly associated with right upper lobectomies, the other patient characteristics and perioperative results were similar between the two groups. No significant pulmonary artery injuries occurred in the fissureless group. In subgroup analyses of right upper lobectomy patients, we found no other significant between-group differences in patient characteristics or perioperative results. In multivariate analyses, right upper lobectomy [odds ratio (OR): 0.047, 95% confidence interval (CI): 0.0044-0.49, P=0.011] or smoking index (OR: 1.03, 95% CI: 1-1.07, P=0.048) was the factor predictive of PAL. Conclusions: A dense fissure is not a contraindication for uniportal thoracoscopic lobectomy using the fissureless technique, which is thus safe.

Non-intubated uniportal subxiphoid thoracoscopic extended thymectomy for thymoma associated with myasthenia gravis.

BACKGROUND: To describe a technique of non-intubated uniportal subxiphoid thoracoscopic extended thymectomy. METHODS: Data were collected retrospectively. A single 3-cm transverse incision was made below the xiphoid process. This method for extended thymectomy entails adoption of uniportal subxiphoid VATS combined with using of non-intubated anesthesia for thymoma associated with myasthenia gravis. RESULTS: Ten consecutive patients underwent this procedure successfully. Mean operative time was 102.5 min. Conversion to intubated ventilation or thoracotomy was not required. Mean chest tube duration was 3.5 days. Mean postoperative hospital stay was 4.7 days. Histologic examination showed early-stage thymomas. Side effects were rare. Quantitative MG scores decreased during follow-up. CONCLUSIONS: Patients were uneventfully discharged with fast recovery. This technique may merge the potential benefits of a subxiphoid incision and the non-intubated anesthesia protocol.

The application value of computed tomography in combination with intraoperative noninvasive percutaneous ultrasonic localisation of subpleural pulmonary nodules/ground-glass opacity in uniportal video-assisted thoracoscopy.

INTRODUCTION: This study investigates the application value of preoperative noninvasive computed tomography (CT) localisation, combined with intraoperative percutaneous ultrasonic localisation, in the precise positioning and excision of subpleural pulmonary nodules/ground-glass opacity in uniportal video-assisted thoracoscopic surgery (U-VATS). AIM: To derive the precise positioning and excision of subpleural pulmonary nodules by CT combined with intraoperative percutaneous ultrasonic localisation and to avoid the complications caused by preoperative CT-guided puncture localisation, reduce physiological and psychological stress such as anxiety, CT radiation dose, and treatment cost, and to improve the treatment satisfaction of patients. MATERIAL AND METHODS: A total of 54 patients with subpleural pulmonary nodules/ground-glass opacity (SPN/GGO), who were treated in our hospital from June 2017 to January 2020, were enrolled in this study. The patients were randomly divided into a treatment group (n = 23), and the nodules were scanned by high-resolution CT and marked at the shortest distance on the surface of the body prior to surgery. These pulmonary nodules were relocated by ultrasound at the original CT positioning points in the same body position following the administration of general anaesthesia. Then, the hookwire puncture location was performed under real-time guidance. For the control group (n = 31), the subpleural pulmonary nodules were located by CT-guided puncture and embedding a hookwire prior to surgery. Pulmonary wedge resection was performed by U-VATS in each group. The subpleural nodules were confirmed by the naked eye and rapid pathological diagnosis after surgery. The difference in positioning success rate, positioning time, the incidence of complications, and patient anxiety scores for subpleural pulmonary nodules were compared and analysed between the two groups. RESULTS: A total of 22 cases of subpleural nodules were successfully located in the treatment group at a success rate of 95.6% (22/23). The average positioning time for CT in combination with ultrasound was 22.0 ±5.9 min. In the control group, 31 cases of subpleural pulmonary nodules were satisfactorily located at a success rate of 100% (31/31). The average positioning time of CT was 24.2 ±5.4 min. The difference in positioning success rate and positioning time was not statistically significant (p = 0.24; p = 0.15) between the two groups. The incidence of complications and SAS anxiety scores in the treatment group were lower compared with the control group. The difference was statistically significant (p = 0.002; p < 0.001). CONCLUSIONS: Preoperative CT combined with intraoperative percutaneous real-time noninvasive ultrasonic localisation can accurately locate subpleural pulmonary nodules, with a high degree of safety and good tolerance in patients who are suitable for U-VATS.

Modified left subsuperior segmentectomy via 2-cm uniportal video-assisted thoracoscopic surgery.

Independent subsuperior segmentectomy (S*) via uniportal video-assisted thoracoscopic surgery (VATS) has rarely been reported. We describe our modified technique of performing simplified left subsuperior segmentectomy for a lung nodule, via 2-cm uniportal VATS. The uniportal approach was different from the traditional approach made by blunt separation into the thorax without electrocautery. Our modified technique minimizes damage to the intercostal nerves and muscles. We also simplified the subsuperior segmentectomy procedure according to the findings of three-dimensional (3D) computed tomography angiography and bronchography. Combining these two techniques achieves a new more minimally invasive method for subsuperior segmentectomy.